Wringe Alison, Roura Maria, Urassa Mark, Busza Joanna, Athanas Veronica, Zaba Basia
Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK.
AIDS Care. 2009 May;21(5):632-7. doi: 10.1080/09540120802385629.
Irregular or delayed attendance at HIV treatment clinics among HIV-positive individuals can have negative implications for clinical outcomes and may ultimately undermine the effectiveness of national treatment programmes. This study explores factors influencing attendance at HIV clinic appointments among patients in a rural ward in north-west Tanzania. Forty-two in-depth interviews (IDI) and four focus group discussions were conducted with HIV-infected persons who had been referred to a nearby antiretroviral therapy (ART) clinic, and IDI were undertaken with 11 healthcare workers involved in diagnosis, referral and care of HIV-positive patients. The Health Belief Model was applied to explore the role of health-related beliefs and the perceived barriers and benefits associated with regular clinic attendance. Perceived susceptibility to HIV-related illnesses emerged as an important factor influencing clinic attendance, and was often manifest through expressions of acceptance or denial of HIV status and knowledge of HIV disease progression. Denial of HIV status was often associated with using alternative healers, and could occur prior to, during, or after starting ART. Perceptions of illness severity also influenced HIV clinic attendance, and often evolved in relation to changes in physical symptoms. Barriers to clinic attendance frequently included health systems factors, while physical and social benefits encouraged regular clinic attendance. Self-confidence in being able to sustain clinic attendance was often determined by patients' expectations or experiences of family support. These findings suggest that multi-faceted interventions are required to promote regular HIV clinic attendance, including on-going education, counselling and support in both clinic and community settings. These interventions also need to recognise the evolving needs of patients that accompany changes in physical health, and should address local beliefs around HIV aetiology. Decentralisation of HIV services to rural communities should be considered as a priority to redress the balance between perceived barriers to, and benefits of accessing HIV treatment programmes.
艾滋病毒呈阳性者在艾滋病毒治疗诊所就诊不规律或延迟，可能对临床结果产生负面影响，并最终可能破坏国家治疗方案的有效性。本研究探讨了影响坦桑尼亚西北部一个农村地区艾滋病毒诊所患者就诊的因素。对已被转诊至附近抗逆转录病毒疗法（ART）诊所的艾滋病毒感染者进行了42次深入访谈（IDI）和4次焦点小组讨论，并对11名参与艾滋病毒呈阳性患者诊断、转诊和护理的医护人员进行了IDI。应用健康信念模型来探讨与健康相关的信念的作用以及与定期诊所就诊相关的感知障碍和益处。对艾滋病毒相关疾病的感知易感性是影响诊所就诊的一个重要因素，并且常常通过对艾滋病毒感染状况的接受或否认以及对艾滋病毒疾病进展的了解表现出来。否认艾滋病毒感染状况通常与使用替代治疗师有关，并且可能在开始抗逆转录病毒治疗之前、期间或之后发生。对疾病严重程度的认知也影响艾滋病毒诊所就诊，并且常常随着身体症状的变化而演变。诊所就诊的障碍常常包括卫生系统因素，而身体和社会益处则鼓励定期诊所就诊。能否持续就诊的自信心往往取决于患者对家庭支持的期望或经历。这些发现表明，需要采取多方面的干预措施来促进艾滋病毒诊所的定期就诊，包括在诊所和社区环境中持续进行教育、咨询和支持。这些干预措施还需要认识到随着身体健康变化患者不断变化的需求，并且应该解决围绕艾滋病毒病因的当地信念。应优先考虑将艾滋病毒服务下放到农村社区，以纠正获得艾滋病毒治疗方案的感知障碍和益处之间的平衡。
